Oncologists Call for Clinical Pathways Reform

by Amanda Conschafter, blog editor

A tool designed to deliver cost-effective, quality cancer care needs reform, announced the American Society of Clinical Oncology (ASCO) in a January policy statement. Known as “clinical pathways,” these protocols incorporate medications’ safety, toxicity, efficacy and cost into a prescribed course of cancer treatment. But as their popularity with insurers has grown, so have oncologists’ worries that a “cookie cutter” approach may jeopardize cancer care.

[WATCH Clinical Pathways: When Personalized Health Care Goes Off Course]

In response, ASCO created a task force to explore the use of clinical pathways in cancer care. The task force’s report acknowledges the value of pathways in offering quality care for certain patients when pathways are “appropriately designed and implemented.” Yet concerns remain.

Concerns about Clinical Pathways

“The manner in which pathways are currently being developed and used in oncology has raised significant concerns,” ASCO explains in its statement. Those concerns include:

  • Barriers to patient access. ASCO warns that pathways can “place too much emphasis on cost control,” restricting patient choices and taking patient care decisions outside the physician-patient relationship.
  • Quality of care. Pathways can focus almost solely on anticancer medications—ignoring “critical aspects of cancer care” such as diagnostics, lab tests and palliative care.
  • The process of developing clinical pathways lacks transparency, leaving patients and health care providers to question how well have conflicts of interest been managed and scientific evidence has been incorporated.

Administrative Challenges & Care Delays

Pathways can also create an unsustainable administrative burden. Clinicians must manage an increasing number of pathways, matching specific requirements to the patients that adhere to them. And when oncologists determine that the anticancer treatment dictated by a pathway isn’t right for a given patient, they may face an arduous process of dealing with insurers.

In an interview with Medscape Medical News, task force member Robin Zon, MD, described treating a patient whose pathway called for a drug that wasn’t right for “that patient’s age, comorbidities, and other characteristics.” Dr. Zon opted for an alternative therapy that was not on the pathway but better suited the patient’s needs. As a result, she and her staff “spen[t] several days documenting and justifying the reasons for the substitution, which led to a delay of a week in the patient’s care.”

ASCO Recommendations

ASCO offered several recommendations for improving the development and use of clinical pathways. These include:

  1. A collaborative, national approach to reducing pathways’ administrative burden
  2. A transparent, consistent process for developing oncology pathways
  3. Ensuring that pathways address the full spectrum of cancer care
  4. Recognizing patient variability and allowing physicians to easily diverge from pathways when needed
  5. Robust criteria to support certification of oncology pathway programs
  6. Research to understand the impact of pathways on care and outcomes.

To learn more, read the complete “American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology.”


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